| Laparoscopy | |
|---|---|
 Illustration of Laparoscopy | |
| ICD-9-CM | 54.9 |
Laparoscopic hernia repair is the repair of a hiatal hernia using a laparoscope, which is a tiny telescope-like instrument. [1] [2] [3] [4] A hiatal hernia is the protrusion of an organ through its wall or cavity. [5] There are several different methods that can be used when performing this procedure. Among them are the Nissen Fundoplication and the general laparoscopic hernia repair.
There are two types of hiatal hernias. The two different types of hiatal hernias that are relevant to this surgery are rolling hiatal hernias and sliding hiatal hernias. A type II, rolling hiatal hernia, is when the gastric fundus is herniated, but the cardia portion of the stomach remains still. A type 1, or sliding hiatal hernia, is when the gastroesophageal junction and the cardia portion of the stomach move through the posterior mediastinum. [5]
There are several different methods when performing a laparoscopic hernia repair. A few of these are the fundoplication and the general laparoscopic hernia repair.
In bariatric surgery, hernias are repaired laparoscopically anteriorly, rather than posteriorly as in the fundoplication procedure. This general laparoscopic procedure was introduced by Sami Salem Ahmad from Germany. The Nissen fundoplication procedure was first performed by Rudolph Nissen in 1955.[ citation needed ]
A laparoscopic hernia repair is when the hiatal hernia is corrected using a covering for the mesh that is used to repair the weakened area. The defect is then measured and the mesh is stapled into place. [6] A benefit of performing Laparoscopic hernia repair is shorter recovery times compared to other methods. However, it is a longer procedure than most other methods of repair. [7]
The Nissen fundoplication procedure consists of a 360 degree transabdominal fundoplication. A fundoplication is the suturing of the fundus located in the stomach and around the esophagus. [5] The procedure itself is performed with the patient in a low lithotomy position at approximately 25 degrees. After the esophagus is mobilized, the crura is moved posteriorly using sutures to make room for a French bougie. When in place, a wrap is created and sutured to the esophagus and to the right crus at the hiatus as well. After this is performed, the bougie is removed and the wrap is further anchored with additional sutures. The trocar sites are then closed. [5]
When performing a laparoscopic hernia repair, patients undergoing the procedure face complications such as postoperative urinary retention (PUR). Another potential complication is requiring a second hernia repair after previously having one at an earlier time. [8] Some complications can arise from the need for general anesthesia in having an open ventral hernia repair. [9] Inherent risks are associated with the use of anesthesia.
General complications that can occur using any method of hernia repair are: [10]
Some complications that can arise from the general laparoscopic procedure are PUR (postoperative urinary retention) [11]
Other complications that can arise during this procedure are: [12]
Complications that can arise form this procedure are: [5]
Overall, the complication rate for this procedure is about 10% to 20%. The failure rate, or inability to repair the hernia, is approximately 5%. [5]
The outcomes of laparoscopic hernia repair versus open hernia repair support laparoscopic hernia repair as the method of choice. Outcomes from having laparoscopic hernia repair are: [13]
A laparoscopic hiatal hernia repair results in a hospital stay of approximately 36 to 48 hours after the procedure has been performed [5]
Laparoscopic hernia repair has several benefits compared to performing Open hernia repairs.[ citation needed ]
Benefits are: [5]
Gastroenterology is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract, sometimes referred to as the GI tract, which includes the esophagus, stomach, small intestine and large intestine as well as the accessory organs of digestion which include the pancreas, gallbladder, and liver. The digestive system functions to move material through the GI tract via peristalsis, break down that material via digestion, absorb nutrients for use throughout the body, and remove waste from the body via defecation. Physicians who specialize in the medical specialty of gastroenterology are called gastroenterologists or sometimes GI doctors. Some of the most common conditions managed by gastroenterologists include gastroesophageal reflux disease, gastrointestinal bleeding, irritable bowel syndrome, inflammatory bowel disease (IBD) which includes Crohn's disease and ulcerative colitis, peptic ulcer disease, gallbladder and biliary tract disease, hepatitis, pancreatitis, colitis, colon polyps and cancer, nutritional problems, and many more.
A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. The term is also used for the normal development of the intestinal tract, referring to the retraction of the intestine from the extra-embryonal navel coelom into the abdomen in the healthy embryo at about 7½ weeks. Various types of hernias can occur, most commonly involving the abdomen, and specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral. Other types of hernias include hiatus, incisional, and umbilical hernias. Symptoms are present in about 66% of people with groin hernias. This may include pain or discomfort in the lower abdomen, especially with coughing, exercise, or urinating or defecating. Often, it gets worse throughout the day and improves when lying down. A bulge may appear at the site of hernia, that becomes larger when bending down. Groin hernias occur more often on the right than left side. The main concern is bowel strangulation, where the blood supply to part of the bowel is blocked. This usually produces severe pain and tenderness in the area. Hiatus, or hiatal hernias often result in heartburn but may also cause chest pain or pain while eating.
Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esophagus. Achalasia can happen at various points along the gastrointestinal tract; achalasia of the rectum, for instance, may occur in Hirschsprung's disease. The lower esophageal sphincter is a muscle between the esophagus and stomach that opens when food comes in. It closes to avoid stomach acids from coming back up. A fully understood cause to the disease is unknown, as are factors that increase the risk of its appearance. Suggestions of a genetically transmittable form of achalasia exist, but this is neither fully understood, nor agreed upon.
Heller myotomy is a surgical procedure in which the muscles of the cardia are cut, allowing food and liquids to pass to the stomach. It is used to treat achalasia, a disorder in which the lower esophageal sphincter fails to relax properly, making it difficult for food and liquids to reach the stomach.
Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases in which stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/or complications. Symptoms include dental corrosion, dysphagia, heartburn, odynophagia, regurgitation, non-cardiac chest pain, extraesophageal symptoms such as chronic cough, hoarseness, reflux-induced laryngitis, or asthma. In the long term, and when not treated, complications such as esophagitis, esophageal stricture, and Barrett's esophagus may arise.
A hiatal hernia or hiatus hernia is a type of hernia in which abdominal organs slip through the diaphragm into the middle compartment of the chest. This may result in gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) with symptoms such as a taste of acid in the back of the mouth or heartburn. Other symptoms may include trouble swallowing and chest pains. Complications may include iron deficiency anemia, volvulus, or bowel obstruction.
A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal, Belsey, Dor, Lind, and Toupet fundoplications are alternative procedures with somewhat different indications and outcomes.
The cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complications may include recurrent urinary tract infections and urinary retention. Cystocele and a prolapsed urethra often occur together and is called a cystourethrocele. Cystocele can negatively affect quality of life.
Femoral hernias occur just below the inguinal ligament, when abdominal contents pass through a naturally occurring weakness in the abdominal wall called the femoral canal. Femoral hernias are a relatively uncommon type, accounting for only 3% of all hernias. While femoral hernias can occur in both males and females, almost all develop in women due to the increased width of the female pelvis. Femoral hernias are more common in adults than in children. Those that do occur in children are more likely to be associated with a connective tissue disorder or with conditions that increase intra-abdominal pressure. Seventy percent of pediatric cases of femoral hernias occur in infants under the age of one.
An incisional hernia is a type of hernia caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are often also classified as ventral hernias due to their location. Not all ventral hernias are from incisions, as some may be caused by other trauma or congenital problems.
Veterinary surgery is surgery performed on animals by veterinarians, whereby the procedures fall into three broad categories: orthopaedics, soft tissue surgery, and neurosurgery. Advanced surgical procedures such as joint replacement, fracture repair, stabilization of cranial cruciate ligament deficiency, oncologic (cancer) surgery, herniated disc treatment, complicated gastrointestinal or urogenital procedures, kidney transplant, skin grafts, complicated wound management, and minimally invasive procedures are performed by veterinary surgeons. Most general practice veterinarians perform routine surgeries such as neuters and minor mass excisions; some also perform additional procedures.
Stretta is a minimally invasive endoscopic procedure for the treatment of gastroesophageal reflux disease (GERD) that delivers radiofrequency energy in the form of electromagnetic waves through electrodes at the end of a catheter to the lower esophageal sphincter (LES) and the gastric cardia – the region of the stomach just below the LES. The energy heats the tissue, ultimately causing it to swell and stiffen; the way this works was not understood as of 2015, but it was thought that perhaps the heat causes local inflammation, collagen deposition and muscular thickening of the LES and that it may disrupt the nerves there.
Urethroplasty is the surgical repair of an injury or defect within the walls of the urethra. Trauma, iatrogenic injury and infections are the most common causes of urethral injury/defect requiring repair. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group.
Pyloromyotomy is a surgical procedure in which a portion of the muscle fibers of the pyloric muscle are cut. This is typically done in cases where the contents from the stomach are inappropriately stopped by the pyloric muscle, causing the stomach contents to build up in the stomach and unable to be appropriately digested. The procedure is typically performed in cases of "hypertrophic pyloric stenosis" in young children. In most cases, the procedure can be performed with either an open approach or a laparoscopic approach and the patients typically have good outcomes with minimal complications.
The angle of His, also known as the esophagogastric angle, is the acute angle created between the cardia at the entrance to the stomach, and the esophagus. It helps to prevent acid reflux of stomach acid into the esophagus. It is commonly undeveloped in infants, making acid reflux more common.
Inguinal hernia surgery is an operation to repair a weakness in the abdominal wall that abnormally allows abdominal contents to slip into a narrow tube called the inguinal canal in the groin region.
A Collis gastroplasty is a surgical procedure performed when the surgeon desires to create a Nissen fundoplication, but the portion of esophagus inferior to the diaphragm is too short. Thus, there is not enough esophagus to wrap. A vertical incision is made in the stomach parallel to the left border of the esophagus. This effectively lengthens the esophagus. The stomach fundus can then be wrapped around the neo-esophagus, thus reducing reflux of stomach acid into the esophagus.
Rudolph Nissen was a German surgeon who chaired surgery departments in Turkey, the United States and Switzerland. The Nissen fundoplication, a surgical procedure for the treatment of gastroesophageal reflux disease, is named after him.
The Sugiura procedure is a surgical technique that involves the removal and transection of the blood vessels that supply the upper portion of the stomach and the esophagus. The procedure also involves a splenectomy. The operation was originally developed to treat bleeding esophageal varices that were untreatable by other conventional methods. It was originally developed as a two-step operation, but has been modified numerous times by many surgeons since its original creation.
Transoral incisionless fundoplication (TIF) is an endoscope treatment designed to relieve symptoms of gastroesophageal reflux disease (GERD). The TIF procedure, similar to Nissen fundoplication, alleviates GERD symptoms by wrapping a portion of the stomach around the esophagus.